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+ r - STAT13 OF CAt}PORNIA <br /> ORIGI�AL THE ASSOURCES AGENCY <br /> File With DWR DEPARTMENT OPWATER RESOURCES Da not fill In <br /> WATER WELL DRILLERS REPORT No. 323478 <br /> St <br /> ice of Intent N _ <br /> a�4923 1 <br /> I <br /> Local Permit No.or Date 89-2228 State Well Na. <br /> _ Other Well No. <br /> Name <br /> Address 230 Industrial Avenue : Total depth ft.Completed depth ft. <br /> City i On CA From ft to ft. Formation(Describe by color,character,size or material) <br /> TIP _ <br /> (2) LOCATION OF WELL(See instructions): - <br /> Cotmty_San Joaquin _Owner's Well Number — <br /> Well address if different from above _ <br /> Township2� <br /> — Range--BE—Section � t <br /> Distance from cities,roads,railroads,fences,etc <br /> { <br /> i <br /> (3) TYPE OF WORK: <br /> See Attached Map New Well 0 Deepening 0 <br /> Reconstruction ❑ — <br /> Reconditioning ❑ i <br /> r Horizontal Well Q — <br /> i Destruction Q (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US _ <br /> Domestic <br /> Irrigation <br /> Industrial EJ <br /> Test Wc11 o ❑ <br /> li Mtmici ❑ _ 0 , <br /> Pill <br /> WELL LOCATION SK6IGFF ibe) nit n _ <br /> (5)EQUIPMENT: CRAV$I� CKa <br /> Rotary Reverse ElNo i <br /> Cable ❑ Air ❑ ! Me I bore <br /> Other ❑ Ruck ❑ ram <br /> (7)CASING INSTALLED (tl)PER TI _ <br /> Steel ❑ P1-41Ic ix Ty of fo on orals or Q i <br /> — I <br /> From Ti Gage or <br /> ft fl C I WnII <br /> II 024 Ch 40 24 <br /> E. - , <br /> (9) WELL SEAL: _ r <br /> Was surfacesantlaryseat provided? Yes Nolj 11 yes,to depth It. <br /> WereamtasealedagainstpothtUon? Yes [X No 0 interval 0-17 fL _ <br /> MctlwdoFsealing Work started 19_8�L Com leted 1J� <br /> 150) WATER LEVELS; WELL DRILLER'S STATEMENT. <br /> Depth of first water,ifknovm ft <br /> This well was drifted under jurisd coon and this report is true to the <br /> Standing level after wellcaopktion ft. oraledg <br /> best of m ea <br /> (11) WELL TESTS: Signed R&haad H. Lake <br /> War well lest made? Yes 13 No IX If yes.by whom? ell Dri W) <br /> ype of test Pump❑ Bailer❑ Air lift ❑ NAME <br /> CO- <br /> Depth to water at <br /> w start ai test ft <br /> At end of test ft. <br /> (Perron,firm,orrnrparrtion)(Typedarprirdal) F <br /> Discharge gal/min after hours Watertemperauue Address <br /> Chemicalaaalysisroade? Yes CX No ❑ If yes,bywhom? City zip__ 9d-3n:?. <br /> Was <br /> d3n3- <br /> Was electric log mada Yes❑ No 1YL if yea attach co to this re rt License No, — Date of this report R 12nIg(f <br /> OYYR 168(FREY. 132-86) IF ADDITIONAL SPACE IS NMDED, USE NEXT CON6BCVYlVELY NVMBtcRED IsOl4IV4 ad 963$3 <br />